GOP health care bill compared with Obama-era law

by RICARDO ALONSO-ZALDIVAR, Associated Press

WASHINGTON (AP) — At first glance, the new health care bill from House Republicans appears to have similarities to the Obama-era law, like tax credits, protections for people with health problems, and the ability of parents to keep young adults on their insurance.

But in most cases those components would work very differently under the GOP framework than is currently the case with the Affordable Care Act, or Obamacare.

Key details about the Republican plan are still unknown, including cost and coverage. Here's a comparison between Obama's ACA, which is current law, and the GOP's bill:

___

COVERAGE

Current law: About 11 million people are covered by expanded Medicaid in the 31 states that accepted it. Nationwide another 12 million buy private health insurance through government-sponsored markets that offer plans with subsidized premiums. The national uninsured rate is below 9 percent, a historic low.

GOP bill: Extent of coverage is unknown at this time, as well as its impact on the nation's uninsured rate.

___

COST

Current law: Coverage costs of about $1.4 trillion from 2017-2026, based on Congressional Budget Office estimates.

Current law: States that accept expanded Medicaid receive a generous federal match, gradually phasing down to 90 percent. The expansion covers people with incomes up to 138 percent of the federal poverty line, or about $16,640 for an individual. Most new beneficiaries are low-income adults with no children living at home.

More broadly, Medicaid is now the country's largest health insurance program, covering more than 70 million people under a federal-state collaboration. It remains an open-ended entitlement, allowing states to draw down federal money for a portion of health costs incurred by low-income people, from children to nursing home residents.

GOP bill: Ends the higher federal match for Medicaid expansion beneficiaries, starting in 2020. States can still continue to receive some enhanced federal payments, but only for expansion enrollees who were already covered before that. States will get a lower match for new enrollees.

But more significantly, the bill would overhaul the framework of Medicaid, ending its open-ended federal financing. Starting with the 2020 fiscal year, each state would receive a limited, per-beneficiary amount based on enrollment and costs. States would gain flexibility to cap enrollment and change benefits. Federal payments would be increased according to a measure of medical inflation. Impacts are unclear.

___

PRIVATE COVERAGE FOR INDIVIDUALS

Current law: Provides income-based tax credits for consumers buying government-regulated plans through HealthCare.gov and state insurance markets. The most generous assistance goes to people with low-to-modest incomes. Many solid middle-class households get no help despite sharp increases in premiums.

GOP bill: Provides tax credits primarily based on age, gradually phasing down for individuals making over $75,000, or married couples earning more than $150,000. Credits can be used to buy any state-licensed health plan. More middle-class consumers will benefit, but there's concern lower-income people would be disadvantaged.

___

DEDUCTIBLES

Current law: Provides cost-sharing subsidies for low-to-moderate income people who buy a standard silver plan in the government markets.

GOP bill: Eliminates ACA's cost-sharing subsidies, but allows people to make much higher contributions to tax-sheltered health savings accounts, to cover deductibles and copayments. Sets up a fund that states can use for a variety of purposes, including cost-sharing assistance.

___

PRE-EXISTING CONDITIONS

Current law: Forbids insurers from turning people down on account of medical problems, or charging them more.

GOP bill: Provides protection for people with health problems. But consumers who have not maintained continuous insurance coverage face a 30 percent premium penalty for a year. States can use federal funds to set up high-risk pools as insurers of last result.

___

GENERATIONAL BALANCE

Current law: Insurers can charge their oldest customers no more than 3 times what they charge young adults. That benefits older adults prone to illness but has made coverage costly for young people.

GOP bill: Insurers could charge older customers up to 5 times what they charge young adults. Advocates for older people complain that's unfair.